An autopsy‐based study of <i><scp>T</scp>rypanosoma cruzi</i> persistence in organs of chronic chagasic patients and its relevance for transplantation

Benvenuti, Luiz Alberto; Roggério, Alessandra; Cavalcanti, Marta M.; Nishiya, Anna S.; Levi, José Eduardo

doi:10.1111/tid.12783

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…This is the consequence of the high rate of CD transmission with heart transplantation observed in a series of patients in which the CD diagnosis was discovered "a posteriori" *21+. This statement is in agreement with a recent autopsy study demonstrating the persistence of T. cruzi in 57.1% of heart samples [63].…”

Section: Indication Screening and Management Of Chagas Disease In Sotsupporting

confidence: 93%

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

Antinori¹,

Milazzo²

2018

obm transplant

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Solid organ transplantation (SOT) is increasingly employed worldwide to treat several diseases causing both acute and chronic organ failure. Recipients of SOT are at an increased risk to develop infections as a consequence of immunosuppressive therapy. Sometimes such infections may be acquired by the transplanted organ or by reactivation of a previously acquired latent infection. The globalization and the increase of international travel poses a risk for exposure to infections such as Chagas disease (CD), leishmaniasis, and malaria endemic in tropical and subtropical areas of the world. We have reviewed the literature regarding risk factors, clinical presentation, diagnosis, and treatment of CD, leishmaniasis, and malaria in the setting of SOT.

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Section: Indication Screening and Management Of Chagas Disease In Sotsupporting

confidence: 93%

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

Antinori¹,

Milazzo²

2018

obm transplant

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“…Considering T cruzi parasites are not cleared from the body of chronic, chagasic patients persisting in several organs, transplanted patients are prone to the relapse of its own infectious disease, that is, CDR . This complication is intimately related to the severity of immunosuppression, and occurs usually in the first year of follow‐up .…”

Section: Discussionmentioning

confidence: 99%

“…Due to persistence of T cruzi parasites in chronically infected patients, and to immunosuppression necessary to allograft maintenance, the infectious disease can reactivate after heart transplantation, with proliferation and dissemination of T cruzi parasites to several organs, particularly the transplanted heart, skin and central nervous system …”

Section: Introductionmentioning

confidence: 99%

“…For these patients, heart transplantation is the best therapeutic option. [3][4][5] Due to persistence of T cruzi parasites in chronically infected patients, 6 and to immunosuppression necessary to allograft maintenance, the infectious disease can reactivate after heart transplantation, with proliferation and dissemination of T cruzi parasites to several organs, particularly the transplanted heart, skin and central nervous system. [3][4][5] The diagnosis of Chagas disease reactivation (CDR) affecting the heart allograft is challenging.…”

Section: Introductionmentioning

confidence: 99%

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Sequential measurement of Trypanosoma cruzi parasitic load in endomyocardial biopsies for early detection and follow‐up of Chagas disease reactivation after heart transplantation

Benvenuti

Roggério

Nishiya

et al. 2019

Transplant Infectious Dis

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Background Reactivation of Chagas disease after heart transplantation is characterized by proliferation and dissemination of Trypanosoma cruzi parasites to several organs. Reactivation affecting the allograft can simulate acute cellular rejection, from which it should be distinguished through the analysis of endomyocardial biopsies (EMB). Methods We evaluated retrospectively 100 EMB collected in the first year of follow‐up from 13 heart‐transplanted, chagasic patients who presented reactivation and were successfully treated. Additionally, 37 EMB from 8 patients who did not present reactivation constituted the control group. We reviewed histopathology and performed a real‐time PCR‐based assay in order to evaluate the T cruzi parasitic load of each EMB. Results The parasitic load of the EMB at the time of reactivation ranged from 22.80 to 190 000/106 cells (median: 1555). In 6 patients, none of the EMB obtained prior to reactivation amplified T cruzi DNA. On the other hand, 10 EMB from 7 patients, obtained 9‐105 days before reactivation (median: 26 days), showed parasitic load ranging from 8.25 to 625/106 cells (median: 167.55). In all patients, the parasitic load increased at the time of reactivation, usually sharply. After initiation of treatment, all patients showed negative PCR or a dramatic reduction of the parasitic load in the following EMB. None of the EMB from the control group amplified T cruzi DNA. Conclusions Sequential measurement of T cruzi parasitic load in EMB is useful for monitoring Chagas disease reactivation after heart transplantation. Its increase suggests imminent reactivation and its decrease after treatment indicates favorable evolution for cure of the episode of reactivation.

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“…The T. cruzi detection in tissues is usually performed using histology [10], immunohistochemistry [11], electron microscopy [12] and PCR [13]. Compared to the traditional detection techniques, PCR demonstrates higher sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Molecular detection of <em>Trypanosoma cruzi</em> from formalin fixed placentas and fetuses of Wistar rats

Costa

Pereira

Júnior

et al. 2019

Matters

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Chagas disease is a tropical disease, endemic of the Americas and caused by the protozoan Trypanosoma cruzi. The classic transmission route of T. cruzi is based on the contact with feces from Triatominae insects containing trypomastigotes forms of the parasite. T. cruzi is also spread by oral and congenital forms, besides blood donation and organ transplant transmission. The parasite has a tropism to several organs and tissues, including heart, brain, digestive tract, muscles, placenta, and fetuses. The determination of parasite burden in organs is an important parameter for scientific assays related to parasite control and epidemiology. Among the procedures to detect and quantify T. cruzi, PCR demonstrates high sensitivity and specificity. In this study, we developed a simple and fast method to detect T. cruzi from fixed placentas and fetuses of Wistar rats. T. cruzi was detected only in tissues from infected animals, with different parasite burdens. Once the histology usually demonstrates some limitations such as low sensitivity and specificity to detect T. cruzi in fetuses, our methodology will be useful for fixed fetal tissues from organ banks. The detection of T. cruzi from gestational tissues will contribute to the elucidation of mechanisms related to congenital Chagas disease.

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An autopsy‐based study of Trypanosoma cruzi persistence in organs of chronic chagasic patients and its relevance for transplantation

Abstract: We concluded that, aside from the heart, the other solid organs of T. cruzi-infected donors can be used for transplantation with a lot of caution. Such organs are not safe in the view of previous reports of CD transmission, but seem to present a low T. cruzi load compared to the heart.

Cited by 22 publications

References 21 publications

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

Sequential measurement of Trypanosoma cruzi parasitic load in endomyocardial biopsies for early detection and follow‐up of Chagas disease reactivation after heart transplantation

Molecular detection of <em>Trypanosoma cruzi</em> from formalin fixed placentas and fetuses of Wistar rats

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